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Article: The effects of COVID-19 on the vestibular system.

Zaubitzer, Lena / Ludwig, Sonja / Berkemann, Michelle / Walter, Beatrice / Jungbauer, Frederic / Held, Valentin / Hegemann, Stefan C A / Rotter, Nicole / Schell, Angela

Frontiers in neurology

2023 Volume 14, Page(s) 1134540

Abstract: Introduction: The symptoms and severity of SARS-CoV-2 infection vary greatly across the spectrum, from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and even death. Dizziness is a frequently reported symptom of SARS- ...

Abstract	Introduction: The symptoms and severity of SARS-CoV-2 infection vary greatly across the spectrum, from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome and even death. Dizziness is a frequently reported symptom of SARS-CoV-2 viral infection. However, the extent to which this symptom results from the effect of SARS-CoV-2 on the vestibular system remains unclear. Materials and methods: In the present single-center, prospective cohort study, patients with a previous SARS-CoV-2 infection underwent a vestibular assessment consisting of the Dizziness Handicap Inventory to assess dizziness during and after infection, a clinical examination, the video head impulse test, and the subjective visual vertical test. When the subjective visual vertical test result was abnormal, vestibular-evoked myogenic potentials were performed. Vestibular testing results were compared to pre-existing normative data of healthy controls. In addition, we performed a retrospective data analysis of patients admitted to hospital presenting with acute symptoms of dizziness who were also diagnosed with acute SARS-CoV-2 infection. Results: A total of 50 participants have been enrolled. During and after the SARS-CoV-2 infection, women were significantly more likely than men to suffer from dizziness. A significantly reduced semicircular canal or otolith function was not observed in either women or men. Acute SARS-CoV-2 infection was diagnosed in nine patients who presented to the emergency room with acute vestibular syndrome. Six of the patients exhibited acute unilateral peripheral vestibulopathy upon diagnosis. A different patient was diagnosed with vestibular migraine, and two individuals had a posterior inferior cerebellar artery infarct revealed by magnetic resonance imaging. Discussion/conclusion: Overall, a persisting structural affection of the vestibular system by SARS-CoV-2 seems to be unlikely and could not be confirmed by vHIT, SVV, and VEMPS in our study. It seems possible but unlikely that SARS-CoV-2 induces acute vestibulopathy. Nevertheless, dizziness is a common symptom in patients with COVID-19, which should be taken and worked through seriously.
Language	English
Publishing date	2023-03-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2023.1134540
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Article ; Online: Diagnosis and Treatment of Vestibular Neuritis/Neuronitis or Peripheral Vestibulopathy (PVP)? Open Questions and Possible Answers.

Hegemann, Stefan C A / Wenzel, Angela

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

2017 Volume 38, Issue 5, Page(s) 626–631

Abstract: The acute vestibular syndrome is a clinically defined entity consisting of vertigo or dizziness that develops acutely over minutes to hours and is accompanied by nausea/vomiting, gait instability, head motion intolerance, and nystagmus, while ... ...

Abstract	: The acute vestibular syndrome is a clinically defined entity consisting of vertigo or dizziness that develops acutely over minutes to hours and is accompanied by nausea/vomiting, gait instability, head motion intolerance, and nystagmus, while persisting over a day or more. When it is caused by a peripheral vestibular lesion and is not associated with clinically manifest auditory deficits, it is mostly labeled vestibular neuritis/neuronitis/neuropathy or sometimes peripheral vestibulopathy. Here, we propose hypotheses and discuss current research advances on viral or vascular factors in the pathogenesis, the recurrence, the site of lesion, old and new treatment options, contraindicated measures, the differential diagnosis, and the prognosis of vestibular neuritis/neuronitis/neuropathy or vestibulopathy. Possibly, other structures than the vestibular nerve are also involved in the pathogenetic process and the label peripheral vestibulopathy would be more apt.
Language	English
Publishing date	2017-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2036790-9
ISSN	1537-4505 ; 1531-7129
ISSN (online)	1537-4505
ISSN	1531-7129
DOI	10.1097/MAO.0000000000001396
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Zs.A 1554: Show issues

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Article ; Online: Acute onset of tinnitus in patients with sudden deafness.

Cvorovic, Ljiljana / Arsovic, Nenad / Radivojevic, Nemanja / Soldatovic, Ivan / Hegemann, Stefan C A

Noise & health

2021 Volume 23, Issue 110, Page(s) 81–86

Abstract: Objective: We made hypotheses that tinnitus will appear more likely in patients with sudden deafness with superior hearing in unaffected ear or with more severe acute hearing loss.: Methods: A retrospective cohort study was performed. Five hundred ... ...

Abstract	Objective: We made hypotheses that tinnitus will appear more likely in patients with sudden deafness with superior hearing in unaffected ear or with more severe acute hearing loss. Methods: A retrospective cohort study was performed. Five hundred forty-one patients were identified with idiopathic sudden sensorineural hearing loss (ISSHL) from January 1995 to August 2006. The exclusion criteria for this study were as follows: bilateral sudden hearing loss and Meniere disease, previous tinnitus or bilateral tinnitus at initial evaluation, and onset of hearing loss less than 7 days. The cohort enrolled 454 patients. The enrolled patients were classified into two groups: patient with acute onset tinnitus in the affected ear and patients without tinnitus at initial visit. Main outcome measures were patient age, the presence or absence of vertigo and tinnitus, audiometric patterns, the severity of hearing loss, and hearing in the unaffected ear. Results: Better contralateral hearing (n = 220 versus n = 72, P < 0.001) and younger age (48 versus 55 years, P < 0.001) were independently associated with the acute onset of tinnitus in patients with ISSHL. The degree of asymmetry between the ears did not differ significantly between patients with and without tinnitus. The sex, presence of vertigo, shape of audiogram, and severity of hearing loss were not correlated with tinnitus occurrence. Conclusions: Tinnitus triggered by ISSHL was more frequent in patients with better contralateral hearing and of a younger age, irrespective of the severity of hearing loss on the affected side or the asymmetry between the ears.
MeSH term(s)	Audiometry ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden/epidemiology ; Humans ; Middle Aged ; Retrospective Studies ; Tinnitus/epidemiology
Language	English
Publishing date	2021-09-28
Publishing country	India
Document type	Journal Article
ZDB-ID	1482372-x
ISSN	1998-4030 ; 1463-1741
ISSN (online)	1998-4030
ISSN	1463-1741
DOI	10.4103/nah.NAH_42_20
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Zs.A 6638: Show issues

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Article ; Online: Constant severe imbalance following traumatic otoconial loss: a new explanation of residual dizziness.

Hegemann, Stefan C A / Weisstanner, Christian / Ernst, Arneborg / Basta, Dietmar / Bockisch, Christopher J

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

2020 Volume 277, Issue 9, Page(s) 2427–2435

Abstract: Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo, caused by otoconia falling from the utricle into a semicircular canal (SCC). After successful repositioning maneuvers residual dizziness (RD) has been described and several ... ...

Abstract	Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo, caused by otoconia falling from the utricle into a semicircular canal (SCC). After successful repositioning maneuvers residual dizziness (RD) has been described and several reasons are used to explain RD. It can last for only a few days or weeks, but also much longer. We present a patient with a severe traumatic loss of otoconia from both maculae utriculi and a persistent imbalance more than 9 years. We think that the loss of otoconia from the utricular and probably also saccular macula induced a sudden reduction of her ability to sense gravity thus logically explaining her symptoms. We show the vestibular test results also supporting our hypothesis and we extrapolate this support to other forms of so far unexplained dizziness especially increasing imbalance with aging. We also discuss the normal c- and oVEMP indicating intact haircell function and supporting our hypothesis of isolated otoconial loss as the major cause for imbalance.
MeSH term(s)	Benign Paroxysmal Positional Vertigo/diagnosis ; Benign Paroxysmal Positional Vertigo/etiology ; Dizziness/diagnosis ; Dizziness/etiology ; Female ; Humans ; Otolithic Membrane ; Saccule and Utricle ; Semicircular Canals
Language	English
Publishing date	2020-04-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-020-05926-8
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Ul II Zs.50: Show issues

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Article ; Online: Correction to: Constant severe imbalance following traumatic otoconial loss: a new explanation of residual dizziness.

Hegemann, Stefan C A / Weisstanner, Christian / Ernst, Arneborg / Basta, Dietmar / Bockisch, Chris J

2020 Volume 277, Issue 9, Page(s) 2437

Abstract: The original article was updated. ...

Abstract	The original article was updated.
Language	English
Publishing date	2020-06-24
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	1017359-6
ISSN	1434-4726 ; 0937-4477
ISSN (online)	1434-4726
ISSN	0937-4477
DOI	10.1007/s00405-020-06159-5
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Article ; Online: About the pathophysiology of acute unilateral vestibular deficit - vestibular neuritis (VN) or peripheral vestibulopathy (PVP)?

Uffer, Denis S / Hegemann, Stefan C A

Journal of vestibular research : equilibrium & orientation

2016 Volume 26, Issue 3, Page(s) 311–317

Abstract: Objective: To determine whether patients with acute unilateral peripheral vestibulopathy (PVP), often called "vestibular neuritis/neuronitis or neuropathy" (VN) have a vestibular lesion pattern consistent with the distribution of the neurological ... ...

Abstract	Objective: To determine whether patients with acute unilateral peripheral vestibulopathy (PVP), often called "vestibular neuritis/neuronitis or neuropathy" (VN) have a vestibular lesion pattern consistent with the distribution of the neurological afferents. Background: Much is known about the clinical nature of PVP, however less so about its etiology and pathogenesis. Due to the frequency with which VN is used to describe the syndrome, an inflammation of the vestibular nerve or of one of its branches is often assumed to be the cause of PVP, though there is insufficient data so far to support this assumption. Methods: We conducted a retrospective study of 25 patients who had presented to our clinic with PVP and had all vestibular receptor organs tested shortly after start of symptoms. We analysed their vestibular lesion patterns in order to determine whether they were consistent with the neuritis hypothesis (NH). Results: The lesion patterns varied conspicuously. 76% did not follow an innervation pattern, thereby contradicting the NH and only 24% had a lesion pattern that either definitely (16%) or probably (8%) supported the NH. Conclusion: These results should remind us to be careful before jumping to quick conclusions about the pathogenetic nature of PVP. With any reason to question VN as the only cause of PVP, we should reconsider the treatment approach to PVP. If the cause probably or even possibly lies inside the vestibular labyrinth, an intratympanic steroid injection might prove to be a more effective measure, even in first-line treatment. If the etiology is unsure, a combination of systemic and intratympanic steroid treatment may be adequate.
Language	English
Publishing date	2016--02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1051840-x
ISSN	1878-6464 ; 0957-4271
ISSN (online)	1878-6464
ISSN	0957-4271
DOI	10.3233/VES-160581
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Zs.A 3072: Show issues

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Conference proceedings: Dynamic visual acuity (DVA) in neurotologic diagnostic

Hegemann, Stefan C. A.

2011 , Page(s) 11hno31

Event/congress	82nd Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery; Freiburg; German Society of Oto-Rhino-Laryngology, Head and Neck Surgery; 2011
Keywords	Medizin, Gesundheit
Publishing date	2011-08-03
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/11hno31
Database	German Medical Science

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Article ; Online: Is superior canal dehiscence congenital or acquired? A case report and review of the literature.

Hegemann, Stefan C A / Carey, John P

Otolaryngologic clinics of North America

2011 Volume 44, Issue 2, Page(s) 377–82, ix

Abstract: This article presents a detailed case report of a patient who was diagnosed with superior canal dehiscence at 37 years of age, but who had a suspicious history for that syndrome from at least 10 years of age. The authors hypothesize several reasons for ... ...

Abstract	This article presents a detailed case report of a patient who was diagnosed with superior canal dehiscence at 37 years of age, but who had a suspicious history for that syndrome from at least 10 years of age. The authors hypothesize several reasons for this late diagnosis, with the goal of helping pediatricians, otolaryngologists, and neurologists consider this syndrome in their differential diagnosis of children, adolescents, or adults experiencing dizziness.
MeSH term(s)	Adult ; Audiometry ; Humans ; Labyrinth Diseases/congenital ; Labyrinth Diseases/physiopathology ; Labyrinth Diseases/surgery ; Male ; Otorhinolaryngologic Surgical Procedures ; Semicircular Canals/pathology ; Vestibular Evoked Myogenic Potentials
Language	English
Publishing date	2011-04
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	417489-6
ISSN	1557-8259 ; 0030-6665
ISSN (online)	1557-8259
ISSN	0030-6665
DOI	10.1016/j.otc.2011.01.009
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Zs.B 183: Show issues

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Article ; Online: Effectiveness of systemic high-dose dexamethasone therapy for idiopathic sudden sensorineural hearing loss.

Egli Gallo, Doris / Khojasteh, Elham / Gloor, Martina / Hegemann, Stefan C A

Audiology & neuro-otology

2013 Volume 18, Issue 3, Page(s) 161–170

Abstract: Objective: To evaluate the effectiveness of systemic high-dose dexamethasone therapy for sudden sensorineural hearing loss in comparison to the previous treatment regimen at our clinic with systemic prednisone 100 mg daily for 7 days analyzed in a ... ...

Abstract	Objective: To evaluate the effectiveness of systemic high-dose dexamethasone therapy for sudden sensorineural hearing loss in comparison to the previous treatment regimen at our clinic with systemic prednisone 100 mg daily for 7 days analyzed in a previous study. Methods: We conducted a retrospective review of an electronic patient data base of 79 patients with idiopathic sudden sensorineural hearing loss. The standard treatment was orally applied dexamethasone (1st to 3rd day: 40 mg daily, 4th to 6th day: 10 mg daily) in an ambulant setting. The primary endpoint was change in hearing threshold from the initial audiogram to an audiogram at least 4 weeks later. Factors that were analyzed included patient's age, interval between onset of symptoms and start of treatment, presence or absence of dizziness and tinnitus, the audiogram pattern, severity of hearing loss and hearing in the opposite ear. Hearing gain was expressed either as absolute or relative hearing gain. Functionally relevant recovery of hearing was defined as the final pure-tone average (PTA) of 30 dB or less (or the same as the PTA of the opposite ear ± 10 dB). Furthermore, we calculated the percentage of patients with complete, partial and no recovery as defined in the recently published Clinical Practice Guideline of the American Academy of Otolaryngology - Head and Neck Surgery Foundation. We then compared our results with the previous treatment regimen carried out at our clinic. Results: The average initial PTA hearing loss in the affected ear compared to baseline PTA of the unaffected ear was 51.5 ± 20.9 dB (mean ± SD). The mean absolute hearing gain was 44.4 ± 18.1 dB. The mean relative hearing gain was 86 ± 19%. Of the total, 87% had functionally relevant recovery of hearing. All of our patients showed partial (24%) or complete recovery (76%). No difference in recovery rate could be detected between patients with start of therapy within 24 h and patients with beginning of therapy within 7 days. We found a correlation between the severity of hearing loss and functionally relevant recovery. A mild hearing loss was noted in 34% of patients, with an average relative hearing gain of 89% and a functionally relevant recovery in 96% of them; the 9% of patients with initial deafness showed a mean relative hearing gain of 69% and a functionally relevant recovery in 43%. The audiogram pattern with low- or high-frequency hearing loss showed the best recovery rate; the poorest recovery rate was found in patients with initial deafness. Conclusion: Application of high-dose orally applied dexamethasone seems to improve the recovery outcomes in comparison to prednisone 100 mg p.o. for 7 days.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Audiometry, Pure-Tone ; Child ; Dexamethasone/administration & dosage ; Dexamethasone/therapeutic use ; Female ; Glucocorticoids/administration & dosage ; Glucocorticoids/therapeutic use ; Hearing Loss, Sensorineural/diagnosis ; Hearing Loss, Sensorineural/drug therapy ; Hearing Loss, Sudden/diagnosis ; Hearing Loss, Sudden/drug therapy ; Humans ; Male ; Middle Aged ; Recovery of Function ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome
Chemical Substances	Glucocorticoids ; Dexamethasone (7S5I7G3JQL)
Language	English
Publishing date	2013
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1314086-3
ISSN	1421-9700 ; 1420-3030
ISSN (online)	1421-9700
ISSN	1420-3030
DOI	10.1159/000346938
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Zs.A 4518: Show issues

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Article ; Online: A dynamic model for eye-position-dependence of spontaneous nystagmus in acute unilateral vestibular deficit (Alexander's Law).

Khojasteh, Elham / Bockisch, Christopher J / Straumann, Dominik / Hegemann, Stefan C A

The European journal of neuroscience

2013 Volume 37, Issue 1, Page(s) 141–149

Abstract: Spontaneous nystagmus (SN) is a symptom of acute vestibular tone asymmetry. Alexander's Law (AL) states that slow-phase velocity of SN is higher when looking in the direction of fast-phases of nystagmus and lower in the slow-phase direction. Earlier ... ...

Abstract	Spontaneous nystagmus (SN) is a symptom of acute vestibular tone asymmetry. Alexander's Law (AL) states that slow-phase velocity of SN is higher when looking in the direction of fast-phases of nystagmus and lower in the slow-phase direction. Earlier explanations for AL predict that during SN, slow-phase eye velocity is a linear function of eye position, increasing linearly as eye deviates towards the fast-phase direction. Recent observations, however, show that this is often not the case; eye velocity does not vary linearly with eye position. Such new findings necessitate a re-evaluation of our understanding of AL. As AL may be an adaptive response of the vestibular system to peripheral lesions, understanding its mechanism could shed light on early adaptation strategies of the brain. Here, we propose a physiologically plausible mechanism for AL that explains recent experimental data. We use a dynamic control system model to simulate this mechanism and make testable predictions. This mechanism is based on the known effects of unilateral vestibular deficit on the response of the ipsi- and contralesional vestibular nuclei (VN) of the brainstem. This hypothesis is based on the silencing of the majority of ipsilesional VN units, which creates an asymmetry between the responses of the ipsi- and contralesional VN. Unlike former explanations, the new hypothesis does not rely on lesion detection strategies or signals originating in higher brain structures. The proposed model demonstrates possible consequences of acute peripheral deficits for the function of the velocity-to-position neural integrator of the ocular motor system and the vestibulo-ocular reflex.
MeSH term(s)	Humans ; Models, Neurological ; Nystagmus, Pathologic/physiopathology ; Reflex, Vestibulo-Ocular ; Vestibular Nuclei/physiopathology ; Vestibule, Labyrinth/physiopathology
Language	English
Publishing date	2013-01
Publishing country	France
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645180-9
ISSN	1460-9568 ; 0953-816X
ISSN (online)	1460-9568
ISSN	0953-816X
DOI	10.1111/ejn.12030
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